Aging is an inevitable process that occurs with time. For us humans, it begins with birth and continues throughout life. As we age there comes age-related changes and deterioration in health. For this reason older people often require delicate care and management as many chronic conditions are common among their population. These age-related changes also are the prime factors that predispose them to various illnesses. Although function is maintained under normal circumstances, the frail elderly’s body particularly the respiratory and cardiovascular system will have a diminished efficiency and responds less efficiently to stress making them vulnerable to respiratory problems and heart diseases which are the major causes of morbidity and mortality among them. Hence, home and health care facilities catering to older people should have standard equipment in order to respond readily to any health crisis. One such important device would be the pulse oximeter.

Knowing the blood oxygen level is crucial for assessment of a person’s overall condition. And because the elderly is prone to develop ailments that may affect his/her oxygenation status, a pulse oximeter would be very useful. This handy device is used to measure the arterial blood oxygen saturation by means of a sensor attached to the subject’s finger, earlobe, nose, toe, or forehead. It not only measures the oxygen saturation of the blood, but reading the pulsatile signals will also yield the current heart rate of the user. Normally, the reading of the O₂ saturation should be between 95 to 100%, while the heart rate between 60 and 100 beats per minute.

Because of its accuracy and non-invasiveness, the pulse oximeter has been the method of choice in identifying cases of hypoxemia or low blood oxygen in the elderly. Unlike having blood tests which require puncturing the skin with a needle which can only be done periodically, the device offers a continuous monitoring system. And depending on the type of oximeter unit you have, you can also store these data for future use. Some may even include printing an oximetry report which is a crucial information for the health team to assess. The great thing about the pulse oximeter is that it can even immediately detect hypoxemia before clinical signs and symptoms appear such as dusky skin and bluish nailbeds develop, thus avoiding late management and life-threatening events.

Pulse oximetry is a quick and inexpensive method of assessing oxygenation.  A reading below 95% would indicate that the person using it may be receiving inadequate amount of oxygen which may be secondary to common illnesses in the older adult like pneumonia, heart failure, and cardiac arrhythmias. In some situations, the elderly may also be severely anemic and have inadequate oxygen to supply the tissues.

However, you should also consider some factors in the elderly which can affect the results of oximetry. To ensure reliability of the results, the one conducting the pulse oximetry monitoring or spot checking must assess whether the elderly is taking any medications that can cause the constriction of blood vessels such as decongestants, stimulants, and antihistamines. Vasoconstriction may cause less blood flow thus a falsely lowered reading.  Another is to determine whether the site of application has good circulation. And lastly, thickened nails in older persons may make finger and toe sensors inaccurate.

The pulse rate and oxygen saturation in the elderly will reflect how well the respiratory and cardiovascular system is doing. And because any issues concerning these two systems will have a great impact on the entire well-being of the patient, it is essential that the oxygen saturation should be monitored regularly, especially with the fragile elderly.

Pulse oximeters with various types of sensors are available from several manufacturers. Wired units are commonly used in hospitals and large health care facilities. They have some added feature which will aid in storing data and facilitate better delivery of results. If the client requires frequent or continuous home monitoring, cordless units are also available which are less expensive compared to the conventional ones. They are also smaller and lighter which is ideal to be carried around by elderly patients.

Saving or trying to cut your medical expenses isn’t a bad thing.  But shopping for medical equipment requires careful decision-making. You have to consider the needs of the person who will be using it, the accuracy, as well as the time frame that you would expect to use it.

Useful Features

There is a wide assortment of pulse oximeters with varying features. Clinics and hospitals are most likely to use the large and sophisticated unit that has a large display for easy viewing. Visual and auditory alarms are intended to alert the user for lower than normal pulse rate and oxygen saturation. Some of them may also include a plethysmographic waveform data which is useful to indicate blood perfusion to the site. Other added features like motion-resistance make them very useful for ambulance units. More often, they are used for continuous monitoring of patients especially during administration of an anesthetic. It can also store and print pulse oximeter data whenever necessary. These superior quality tabletop pulse oximeters usually cost a lot but they are very durable and very accurate and reliable which is why hospitals often opt for this type.

Quality and Precision

But if the user only requires periodic assessment of his/her oxygen saturation, physicians may recommend the less-expensive portable pulse oximeters. Leading brands like Nonin and Landon have a wide assortment of handheld and fingertip pulse oximeters with unmatched accuracy. This is probably due to its clean light source within the sensor allowing it to filter interferences like motion and low signal that can skew with the results, and thus reading only the true pulse of the user. This technology is not present in any other brands. You must know that oxygen saturation results are very crucial. If the reading is not very accurate, this may cost the user’s life.

In addition, high-end pulse oximeters should be able to finish a spot check in a matter of seconds. In a fast-paced setting, you would not like to wait for minutes to know the O₂ sats of a person. This will put the patient further at risk for brain damage or even death.

Durability

When you buy a pulse oximeter, you would really want it to last. Some people have medical conditions that require a lifetime of constant oxygen saturation monitoring. You should know how to use it so that you won’t be manipulating the wrong buttons ending up damaging the device.

Maintenance

Some pulse oximeters require no maintenance at all. But just like any gadget, pulse oximeters are also delicate so you should always keep it in a safe place away from children’s reach. Do not allow children to play or use a pulse oximeter unsupervised. People who use them as part of their profession or activities should select the type that can withstand unstable conditions. If your pulse oximeter is not even durable, you will tend to buy a new unit over and over again.

With low-cost comes low-quality. But this doesn’t mean that you have to spend too much. Medical devices come at reasonable prices. You just have to know where to look and what to look for in a gadget. Nowadays, pulse oximeters are equipped with the capacity to store data and several other features. You just have to make sure that you will be using these features. Talk to a specialist or a physician perhaps about what type of pulse oximeter suits you. They can recommend a type with good reputation and one that is ideal for your condition and activities. You might also like to read user reviews to know the pros and cons of a certain pulse oximeter.

Buying low-end pulse oximeters is very risky.  With the monetary difference so small, is it worth sacrificing pigmentation the accuracy, durability, and your own life?

So who are those people required to monitor their blood oxygen levels?

There are many instances in which a person can be deprived of oxygen. Hypoxemia, or the condition where there is a low amount of oxygen in the blood, may be brought about by illness or direct trauma to the structures involved in breathing. As mentioned, people who have respiratory disorders have the greatest chances of developing decreased arterial oxygen saturation. The number one candidates are patients with asthma and chronic obstructive pulmonary disease. Patients who have cardiac diseases should also monitor with their O₂ sats.

Other ailments may also result in lowered blood oxygen levels due to the decreased amount of circulating haemoglobin in the body. Because hemoglobin is the component in a red blood cell that carries the oxygen molecule, it has a direct relationship with the amount of oxygen dissolved in the blood. Hence, blood disorders that can cause a deficiency in haemoglobin or alter the capacity of haemoglobin to carry and transport oxygen such as in iron-deficiency anemia, sicle cell anemia, thalassemia, and carbon monoxide poisoning could possibly result into decreased oxygen saturation levels.

Those who undergo surgery will also have their blood oxygen levels monitored because of the risk of hypoxemia attributed to anesthesia administration. The same goes for pilots and mountaineers climbing thousands of feet above the ground where there is less oxygen present in the air.

The purpose of a pulse oximeter is to read the current amount of oxygen present in your blood by placing the sensor over the fingertip (or sometimes the earlobe). The reading will indicate whether you need to stop your activity, or to have supplemental oxygen. Generally, it will be the doctor who will tell you whether or not you require constant monitoring depending on the grounds that put you at risk for hypoxemia. Parents of children who have asthma are commonly advised to have a pulse oximeter with them especially during play or any strenuous activities. If the results are interpreted as low, then the child will have to stop playing, and take his medications as necessary.

If you are living with an elderly person, a pulse oximeter will also be beneficial. Heart diseases that can lead to oxygen deficiency are the common cause of mortality among the geriatric population. Hence, the pulse oximeter has become a standard equipment present in nursing homes. This hand-held device is proved to be useful in getting a non-invasive yet accurate and continuous reading unlike blood tests which is performed with limit.

Oxygen deficiency could lead to a lot of consequences ranging from light-headedness, fatigue, mood instability, listlessness, to memory problems, lowered immunity, and circulatory problems. If prolonged, oxygen deficiency could cause brain damage, and other vital organs may also become affected. Without immediate and proper intervention, the lack of oxygen in our bodies could be fatal. This is why airway and breathing is a priority during resuscitation, and a pulse oximeter is always present in ambulances, emergency rooms, operating rooms, or any health care facility. Pulse oximeters are also available nowadays for home use. They are portable, light-weight and come under different brands, colours, and features.

There are several other circumstances where a person needs to have constant monitoring of the oxygen saturation levels. It would be better to talk to a specialist regarding the need to have a pulse oximeter with you. Owning one would help you be assured of monitoring your condition at any moment you wish, as well as reduce your expenses for other lab tests. Purchasing a pulse oximeter would be a wise way to spend your money.

Monitoring Asthma

Any disease involving the airways must be assessed with utmost accuracy because of the involvement of a person’s oxygenation. Hence, doctors use a pulse oximeter to find out how well a patient is doing.

The pulse oximeter is a device that shows how much oxygen is present in a subject’s blood. In medicine, they call this the saturation of peripheral oxygen or SpO₂. Ideally, the SpO₂ reading should be between 95 to 100%. Any value below 95% would mean that the person is receiving less oxygen into his body due to a variety of reasons. In the case of asthma, airway obstruction secondary to the inflammation of the air passages is the most probable cause of desaturation.

Pulse oximeters are highly effective instruments for diagnosing and monitoring asthma. They are the first tools used for the assessment of the severity of the condition because they are portable, non-invasive, and can yield immediate results. The physician will simply slip on a probe to the patient’s finger or earlobe. A light-emitting diode (LED) will transmit light through the body part where the probe is clipped. The device will then read how much light is absorbed and reveal the value of the quantity of oxygen saturation in the blood.

Accuracy

Patients presenting with breathing difficulty and/or has a medical history of asthma are often hooked to a pulse oximeter immediately upon arrival for initial assessment. However, many are still quite doubtful on how reliable a small device can be, especially when the pulse oximeter reveals results that are not congruent to the symptoms of the patient.

There might be some instances that a person with asthma may appear “normal” or asymptomatic, and yet the oxygen saturation is quite low. There are a lot of reasons behind this. Nevertheless, a low reading indicates the possibility of desaturation. It will be the physician’s prerogative to perform more tests and physical assessment to aid to his diagnosis.

Traditionally, vital signs include the pulse and breathing rate, as well as one’s body temperature and blood pressure. But because of the increasing needs of ill patients and the rapid change in medical technology, health professionals now consider the oxygen saturation of a person to be the fifth vital sign.  Hence, nowadays, many health care units require the use of pulse oximeters to assess and diagnose various conditions. Several studies have been performed to test the accuracy and sensitivity of pulse oximetry to patients with acute asthma. Most of the time, pulse oximeters are reasonably accurate, but not absolutely as certain factors such as nail polish, movement, anemia and some medical conditions may interfere in getting a good reading. Thus, it is also important to choose a pulse oximeter wisely.

Home Application

Today, manufacturers have found a way in making the pulse oximeter more convenient to use, especially for those who require constant monitoring outside health care facilities. Handheld devices have started to replace the traditional bulky units found in hospitals. Recently, pulse oximeters that only consist of a probe with a tiny colored display have come out to the market. This allows for people to be able determine the presence of hypoxemia brought about by acute asthma exacerbations. In addition, measuring the percentage of hemoglobin that is carrying oxygen within the blood can also be a great way in identifying how well the person is responding to treatment, or when the person needs to rest.

A pulse oximeter can also show the heart rate. Usually, during an asthma attack, the heart rate also rises due to anxiety and in response to the decreasing amount of oxygen entering the respiratory tract. The heart will be the one to compensate for the decreased amount of oxygen distributed throughout the body. This indicates a need for immediate intervention.

With the pulse oximeter, errors in the diagnosis and evaluation of patients with asthma are minimized. Moreover, many are even spared from unnecessary invasive procedures like blood tests in order to determine their state of oxygenation. But as a rule, when in doubt, a battery of tests may also be performed to confirm the presence of a medical condition.

The Role of Paramedics

Every now and then, large numbers of people seek emergency care for serious life-threatening situations, such as heart attack, stroke, acute respiratory distress, as well as trauma. Hence, we require people who have a more advanced skill in providing life support and acute medical care to any person needing it, this include the auxiliary services rendered by paramedics.

Paramedics are medical personnel who offer a high-level of assessment and pre-hospital management at any emergency scenarios. They are usually found in ambulances or disaster units responding to emergency calls. And just like physicians, they are educated on how to treat patients during crisis periods.

But before they will be able to render medical care to their patients, paramedics should assess the condition first. To do this, they have to utilize various equipment for examination. This is very crucial because the management of the patient will depend on the outcome of the assessment. In today’s time, one of the most important equipment to yield in-depth information of the condition of the patient is the pulse oximeter.

Emergency Pulse Oximetry

The oxygenation status of a person is difficult to determine through observation alone. A more reliable means would either be drawing a patient’s blood sample, or by using a pulse oximeter. Compared to drawing blood samples, the latter is a non-invasive method of measuring the oxygen saturation of the blood that yields almost equally reliable information as with the former. In the EMS system, there is no doubt that the pulse oximeter may serve for several functions.

A pulse oximeter is a device that consists of a probe that is usually placed on a person’s finger to read the amount of oxygen present in the blood. Traditionally, it is used to detect hypoxemia, a condition in the blood where there is low oxygen, specifically an O₂ saturation below 90%. This is dangerous as low blood oxygen levels may result to irreversible brain damage and consequently, death. By knowing such, trained medical personnel will understand when to provide oxygen therapy as necessary.

Because of its capacity to determine oxygen perfusion, the pulse oximeter too may help assess the circulation at certain points of the body, such as the limbs. This is incredibly useful in cases of injury to the extremities where the pulse is not palpable.

Whether it is for one-time or for continuous use, the pulse oximeter is also a great means to cut costs for acute medical care. By performing pulse oximetry, a paramedic will know the real-time oxygenation status of a person and subsequently determine if there is a need for supplemental oxygen.

Things to consider

However, before using one, it is also important to consider what type of device you have as well as its features because there are certain factors that may interfere with getting an accurate reading. Presently, there are several types of pulse oximeters available. Some may include a bulky table unit that houses the display and alarm systems which is suitable for hospital or bedside use. Other models are handheld types that can the user can simply carry around. The latest variety comprises of only a fingertip probe with a small display incorporated on the unit.

Motion-resistance

For a paramedic who is always on the move, it is essential that the pulse oximeter must offer portability and speed in relaying the results while maintaining accuracy.

Most of the time, pulse oximeters can be very sensitive to motion. This means that the user’s movements may interfere with getting a precise SpO₂ reading. Therefore, a suitable pulse oximeter to be used must have a motion-resistant capacity.

Appropriate Display

Visibility of the results is always an important consideration for every medical device. In some environments where audible alarms may not be heard, paramedics shall rely on visual cues elicited from the pulse oximeter. As much as possible, the display panel should not strain the user’s eye for him to read the results.

Fast Reading

Emergency responders are always battling with time. Hence, devices that must be used should be able to yield results in a timely manner. The same goes for a pulse oximeter. The good thing is that newer pulse oximeters are fast and easy to use, and they usually take only a few seconds to get a reading.

Pulse Oximeters are widely used in hospitals or in any health care setting. When used properly, they are one of the key assessment tools to aid in diagnosis of certain conditions. In addition, they can also be used as an instrument for evaluation of a disease process. Hence, it is imperative that the one operating the device is knowledgeable about pulse oximetry and how to use it.

In young patients, there are a number of scenarios in which a pediatric pulse oximeter can be used.  Primarily, it can be used to detect conditions such as hypoxemia, a deficiency in the concentration of oxygen in the blood secondary to an inadequate ventilation or poor circulation.

A study has shown that the application of a pulse oximeter in newborns may detect congenital heart disease prior to hospital discharge which facilitates early diagnosis.* In some way, this is beneficial as the defects are identified ahead of time and lowers the risk of serious complications. Other conditions in children where a pulse oximeter would be beneficial are those like asthma, situations requiring intensive care such as mechanical ventilation, oxygen administration, and certain respiratory and cardiovascular disorders.

In terms of appearance, pediatric pulse oximeters are typically wireless or simply the fingertip type as children have the tendency to move about, and corded equipments would cause more jeopardy than safety. Motion artifact, low perfusion capacity and other interferences that affect the accuracy of the results may vary per brand. But in general, its main function of identifying the SpO₂ level and pulse rate is basically the same.

*http://circ.ahajournals.org/cgi/content/short/CIRCULATIONAHA.109.192576v1

Oxygen that is inhaled from the atmosphere diffuses through the lungs and into the bloodstream to be used up by body tissues for energy. In the blood, most of the oxygen is bound to the hemoglobin component of a red blood cell while a few are dissolved in plasma. A pulse oximeter reads the concentration of oxygen bound to hemoglobin in the blood by shining infrared and red light through a translucent part of the body and measuring the ratio of light reflected and light absorbed by oxygenated and deoxygenated hemoglobin. Hence, it becomes a good indicator of the oxygenation status of a person, especially hypoxemia.

Pulse oximeters read the value of the saturation of peripheral oxygen or SpO₂ or simply the oxygen saturation of the peripheral blood. The value is read in percentage form. In most literature, the accepted normal value of a pulse oximeter reading is between 95-100%. Anything that falls below 95% is already categorized as hypoxemia. That’s why it would be necessary to set the alarm (if any) at 95%. When the reading is at 85% and below, the person is already at a critical level. Cerebral hypoxia (low oxygen level in the brain) may follow in a few minutes and cause irreversible brain damage. Several vital organs might also be affected. The person warrants immediate treatment and oxygenation.

Oxygen saturation can never be more than 100%. But the results may display 100% and still exhibit signs of hypoxia. This happens in cases of anemia because of a low blood hemoglobin level and carbon monoxide poisoning.

Reading a pulse oximeter is easy, but the accuracy of the results rests on several factors, limitations, and medical conditions. Hence, before the interpretation of a result, it is essential to make a quick but thorough assessment of the person’s condition.

Pulse oximeters are relatively safe as there is no harm done by merely clipping a probe to a finger, ear, or certain parts of the body. Because of their non-invasive and quantitative nature, they are most preferred by physicians and experts in the assessment of the oxygenation status of a person. No one would ever want themselves to experience hypoxia, a condition in which body tissues are deprived of oxygen. Of course that is potentially fatal if it persists for several minutes. Hence, a lot of health-conscious people are buying pulse oximeters as part of their self-monitoring systems, particularly those who are prone to environments or scenarios that could possibly reduce the oxygen levels in their body.

Pulse oximetry has been available to pilots riding non-pressurized aircraft during the late 1900s and is still being advocated in the field of aeronautics up to the present time. It would be extremely necessary for them to monitor their oxygen saturation because they are climbing to higher altitudes where there is lesser oxygen in the atmosphere. With a pulse oximeter, pilots can identify for themselves whether or not they need supplementary oxygen. The same goes for mountain climbers who desire to climb higher elevations.

Sports athletes have also considered the pulse oximeter to be very useful. They wanted to monitor whether their increased activity is already compromising their health as strenuous exercise runs the risk of causing hypoxia. But by measuring the oxygen saturation of the blood, athletes will be able to assess how their body is responding to physical activity.

There are various types of pulse oximeters that are ideal for these scenarios. A hand-held type or a finger pulse oximeter that is motion-resistant would be the best option for pilots, mountaineers, and runners.  For a cyclist, a wrist oximeter such as the PC-68B from Landon Medical is much preferred to avoid interfering with holding the handlebars.

Fingertip

Most probes are designed to be clipped unto a finger. The main reason behind this is that the digit is the most accessible segment of the body. It can be monitored for any interferences or factors that can affect the accuracy of a reading such as obstructed blood flow.

One issue in using a fingertip probe is the presence of acrylic or nail polish. Earlier studies have proven that certain dyes and nailpolish can affect the measurement of oxygen saturation, particularly black, green, and blue on the basis of spectrophotometry. They have concluded that it should be a routine procedure to remove any nailpoilish prior to pulse oximeter usage. However, with the continued development in pulse oximeter technology, most modern devices are already designed to sort out tissues and interferences such as a nail polish, making them more accurate as ever.

Earlobe

Earlobe sensors are like fingertip probes that can be clipped either on the tip or lower part of the pinna (earlobe). They are used whenever there are medical anomalies with the hands or fingers that hinder precise measurement of oxygen saturation.

Toes

In terms of translucency, the toes are as good as the fingers as a pulse oximeter measuring site. The toes may be used depending on the condition of a person–pulse oximetry of the toes is very helpful in detecting problems in arterial blood flow such as in lower extremity arterial disease.

In neonates, the big toe is more preferred site.

Soles and Palm

The sole of the foot is another measuring site that is used commonly in infants. Pulse oximeter probes that are used on the palm and soles utilize a wrap sensor instead of the ones that are clipped. Currently, no wireless sensor has been created to use on the palm and sole.

Sleep apnea is a sleeping disorder in which a person pauses in breathing for 10 seconds or more that occur repeatedly during sleep. The problem with such condition is its capacity to cause sleep and oxygen deprivation that may result to certain complications. At present, the main diagnostic tool for sleep apnea is through a polysomnogram or otherwise called a “sleep study”.

Polysomnography is a test performed at a sleep center where the person with suspected sleep apnea will stay overnight. The device uses several electrodes that monitors and records any biophysiologic changes that occur during sleep such as a person’s brain activity, heart rate, breathing, body movements, and a few others. During the test, changes in oxygen saturation are also measured; hence, a pulse oximeter plays an integral part in screening for sleep apnea. Ideally, polysomnography is the only accepted method of diagnosis. However, its lack of general availability and high cost makes it arduous for patients to get diagnosed and be rendered with immediate treatment.

The use of home overnight pulse oximeter as a screening tool for obstructive sleep apnea has been suggested hoping that such device alone will eventually replace the need for sleep clinics. Pulse oximeters have been shown to be very specific, but on the contrary studies revealed that pulse oximeters are not sensitive enough to detect mild sleep apnea as it does with the more severe forms of the disorder. It may have a high sensitivity and specificity in people with 25 or more fluctuations in oxygen saturation (desaturation) per hour, but their sensitivity drops between 60 to 80% in people with less than 15 desaturations per hour. Hence, experts conclude that pulse oximeters alone are not a reliable means of screening for sleep apnea. They shall be used in conjunction with a polysomnogram test and clinical data for a more accurate result and diagnosis.